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Mental and behavioral health disparities differed significantly by race/ethnicity among adults and youth.
Disparities Were as Much as 14 Times Greater for American Indian/Alaska Native Youth
American Indian/Alaska Native adults and youth face persistent disparities in mental and behavioral health with little improvement over time. This is consistent with findings of previous America’s Health Rankings reports, which found that American Indian/Alaska Native populations experienced disproportionately higher and increasing rates of drug death and teen suicide compared to other racial and ethnic groups.
In 2021, American Indian/Alaska Native adults experienced a 3.4 times higher rate (28.3%) of substance use disorder (SUD) compared to Asian adults (8.4%). SUD includes alcohol or drug use — including use and misuse of prescription drugs — in the past year. Additionally, compared to Asian adults (8.3%), American Indian/Alaska Native adults also experienced a 3.0 times higher rate (24.6%) of illicit drug use, which includes cocaine, hallucinogens, heroin, inhalants, methamphetamine and/or misuse of prescription drugs.
American Indian/Alaska Native children (ages 0-17) had a 14.2 times higher likelihood of being exposed to two or more household-level adverse childhood experiences (ACEs) (31.2%) compared to Asian (2.2%), 3.0 times higher compared to Hispanic (10.3%) and 2.0 times higher than Black (15.9%) and multiracial (15.5%) children. Household-level ACEs include: divorce; death or imprisonment of a parent or guardian; living with anyone who was mentally ill, suicidal or severely depressed; living with anyone who had a problem with alcohol or drugs; and witnessing physical violence in the home. Stressful and traumatic events that occur in a child’s life affect the health and well-being of youth. In the absence of protective factors, ACEs affect a child’s development and emotional, cognitive, social and biological functioning, with long-lasting impacts into adulthood.1-6
American Indian/Alaska Native youth also experienced relational health risks at a high rate. Relational health risks include having one or more of the following: two or more household-level ACEs; a parent in need of emotional or coping support; a parent with fair or poor mental health; and a parent with high parental aggravation.7 American Indian/Alaska Native youth had a 1.8 times higher rate of relational health risk to their household emotional support (58.3%) compared to white youth (27.1%) in 2021.
Hispanic Adults and Youth Experienced Disproportionate Rates of Major Depressive Episodes
Hispanic adults had a 1.7 times higher rate of having had a major depressive episode in the last year compared to Asian adults (7.8% vs. 4.7%) and Hispanic youth had a 1.5 times higher rate compared to Black youth in 2021 (22.0% vs. 14.4%). The COVID-era Disparities Survey featured in the 2022 Annual Report noted that Hispanic adults reported pandemic-related occupational stress and financial issues, as well as disproportionate loss of close friends or family members due to the COVID-19 pandemic.
Black Adults Experienced Multiple Disparities and Black Youth Had Disproportionate Rates of ACEs
Mental health conditions, such as depression and anxiety, affect a person’s thoughts, feelings, moods and behaviors, and individuals can experience these while also having substance use disorders (SUD).8 Black adults had a 2.2 times higher rate of SUD and a 1.9 times higher rate of co-occurring low-to-moderate mental illness and substance use disorder (LMMI SUD) compared to Asian adults in 2021 (18.6% vs. 8.4% and 5.3% vs. 2.8%, respectively). Furthermore, Black youth had a 7.2 times higher likelihood of being exposed to two or more household-level ACEs compared to Asian youth and a 1.5 times higher rate compared to Hispanic youth (15.9% vs. 2.2% and 10.3%, respectively) in 2021.
Substance Use and Diagnosed Anxiety High Among White Adults and Youth, Respectively
White adults and youth also experienced higher rates of behavioral and mental health challenges. Notably, white adults had a 2.2 times higher rate of illicit drug use compared to Asian adults (18.0% vs 8.3%) in 2021, as well as a 1.9 times higher rate of co-occurring low-to- moderate mental illness and substance use disorder (LMMI SUD) compared to Asian adults (5.4% vs. 2.8%) in 2021. White youth had a 4.2 times higher rate of diagnosed anxiety compared to Asian youth (9.7% vs. 2.3%) in 2021. Previous America’s Health Rankings reports found that white adults experienced disproportionate and increasing rates of non-medical prescription drug use and illicit drug use.
Asian Youth Experienced Wide Disparities in Household Emotional Support
In 2021, Asian adults and youth reported the lowest prevalence of mental health challenges across the measures included in this brief. However, 52.9% of Asian children have a caregiver who is not coping well and/or lacks emotional support for parenting. This rate is 3.4 times higher than among white (15.5%) children, 3.0 times higher than among multiracial (17.9%) children and 1.8 times higher than among American Indian/ Alaska Native (29.3%) and Black (30.2%) children.